ACP Position Paper: Imaging for Uncomplicated Low Back Pain a 'Low-value' Service

Wednesday, October 31, 2012

ACP Position Paper: Imaging for Uncomplicated Low Back Pain a 'Low-value' Service

Public and private payers are widely
using performance measures to assess the use of low-value interventions, such as
imaging for patients with uncomplicated low back pain, and using the results
for public reporting and pay-for-performance, say authors of a position paper
written on behalf of the American College of
Physicians Performance Measurement Committee
and published October 30 in Annuals of
Internal Medicine.

The paper gives an overview of
performance measures that target low-value services in order to help physicians
understand the strengths and limitations of these measures, provides specific
examples of measures that assess the use of low-value services, and discusses
how these measures can be used in clinical practice and policy.

The discussion includes 2
categories of low-value interventions:
(1) those for which the harms probably exceed the benefits (eg, performing
colorectal cancer screening for patients older than age 85 years) and (2) those
that may provide benefits but for which a quantitative assessment of their
benefits and costs by a multistakeholder group (patients, clinicians, and
policymakers) suggests that the tradeoff between health benefits and
expenditures is undesirable (eg, screening for cervical cancer in low-risk
women aged 65 years or older and in women who have had a total hysterectomy for
benign disease).

"Ideally,
performance measures should be based on rigorous study designs (for example,
randomized controlled trials) that assessed the benefits, risks, and costs of
interventions," say the authors. However, to develop performance measures
for low-value services, they suggest that researchers "will probably need
to use data from different types of research design and methods, including
subgroup analyses from clinical trials, cohort studies, cost–benefit analyses,
and cost-effectiveness analyses."

"Just as with
other performance measures, those for low-value services can be used in a
variety of ways to improve quality and health care value," they add.

Read more about the American College of Physicians' (ACP) high-value care initiative that aims to help physicians and patients understand the
benefits, harms, and costs of interventions, and determine whether services
provide good value. Go to the February 2011 issue
of Annuals of Internal Medicine for
free full text of ACP's clinical guideline for diagnostic imaging for patients
with low back pain. The guideline calls for diagnostic imaging only if patients
have severe progressive neurologic deficits or signs or symptoms that suggest a
serious or specific underlying condition.